Diabetic ketoacidosis(DKA)and hyperosmolar hyperglycemia state(HHS)are two life-threatening metabolic complications of diabetes that significantly increase mortality and morbidity.Despite major advances,reaching a uni...Diabetic ketoacidosis(DKA)and hyperosmolar hyperglycemia state(HHS)are two life-threatening metabolic complications of diabetes that significantly increase mortality and morbidity.Despite major advances,reaching a uniform consensus regarding the diagnostic criteria and treatment of both conditions has been challenging.A significant overlap between these two extremes of the hyperglycemic crisis spectrum poses an additional hurdle.It has well been noted that a complete biochemical and clinical patient evaluation with timely diagnosis and treatment is vital for symptom resolution.Worldwide,there is a lack of large-scale studies that help define how hyperglycemic crises should be managed.This article will provide a comprehensive review of the pathophysiology,diagnosis,and management of DKA-HHS overlap.展开更多
AIM:To investigate the mechanism of the tight junction(TJ) disruption and the association between tumor necrosis factor(TNF)-α and matrix metalloproteinase(MMPs) under hyperosmotic condition in primary human corneal ...AIM:To investigate the mechanism of the tight junction(TJ) disruption and the association between tumor necrosis factor(TNF)-α and matrix metalloproteinase(MMPs) under hyperosmotic condition in primary human corneal epithelial cells(HCECs).METHODS:The cultured HCECs were exposed to media which adding sodium chloride(Na Cl) for hyperosmolar stress or adding rh-TNF-α(10 ng/m L). NF-κB inhibitor(5 μmol/L) or GM-6001(potent and broad spectrum MMP inhibitor, 20 μmol/L)was added 1 h before that treatment. The integrity of TJ proteins was determined by immunofluorescent(IF) staining. The m RNA levels of TNF-α and MMPs were evaluated by quantitative reverse transcription polymerase chain reaction(RT-q PCR) and the protein expression by enzyme-linked immunosorbent assay(ELISA).RESULTS:TJ proteins ZO-1 and Occludin were disrupted in primary HCECs exposed to hyperosmotic medium. The m RNA expression and protein production of TNF-α increased significantly in hyperosmotic media at 500 m Os M. TNF-α mediated the expression and production of MMP-1, MMP-13, MMP-9, and MMP-3 stimulated by hyperosmotic stress. The production of MMPs in hyperosmolar media were increased through the increase of TNF-α. GM-6001 prevent the destruction of ZO-1 and Occludin in hyperosmolar stress and rh-TNF-α treated medium. TNF-α induced activation of MMPs was involved in the TJ disruption by hyperosmolarity.CONCLUSION:TJ proteins ZO-1 and Occludin are disrupted by hyperosmolar stress and TNF-α, but protected by MMP inhibitor(GM-6001). It suggests that TNF-α/MMP pathway mediates the TJ disruption in primary HCECs exposed to hyperosmotic stress.展开更多
To protect from COVID-19 pandemic, several vaccines were developed infection with expected immunity against a SARS-CoV-2 infection. Short time side effects are reported. New onset diabetes was reported after SARS-CoV-...To protect from COVID-19 pandemic, several vaccines were developed infection with expected immunity against a SARS-CoV-2 infection. Short time side effects are reported. New onset diabetes was reported after SARS-CoV-2 infection. Here we report a case of new onset diabetes presenting with hyperosmolar hyperglycemic state, whose symptoms followed right after the second dose of Pfizer-BioNTech COVID-19 Vaccine. He is a 56-year old, obese Afro-American Veteran with no family history of diabetes and with HbA1C of 5.6 forty-five days prior to the hospitalization. He noted polyurea and excessive thirst following the second dose Pfizer-BioNTech COVID-19 vaccine. Hospitalized with hyperosmolar state and HbA1C of more than 14, he was treated initially with insulin drip and changed to basal, bolus regimen. In addition, he had new onset of oral thrush, requiring antifungal therapy. He needed higher doses of insulin during hospitalization and at discharge. He rapidly recovered and could be tapered off insulin in 4 months and recovered to normal glycemic state. We conclude that this is the second state to present with hyperosmolar state, and first case with rapid recovery of glycemic state.展开更多
BACKGROUND Diabetic ketoacidosis(DKA)and hyperglycemic hyperosmolar state(HHS)are common acute complications of diabetes mellitus with a high risk of mortality.When combined with hypernatremia,the complications can be...BACKGROUND Diabetic ketoacidosis(DKA)and hyperglycemic hyperosmolar state(HHS)are common acute complications of diabetes mellitus with a high risk of mortality.When combined with hypernatremia,the complications can be even worse.Hypernatremia is a rarely associated with DKA and HHS as both are usually accompanied by normal sodium or hyponatremia.As a result,a structured and systematic treatment approach is critical.We discuss the therapeutic approach and implications of this uncommon presentation.CASE SUMMARY A 62-year-old man with no known past medical history presented to emergency department with altered mental status.Initial work up in emergency room showed severe hyperglycemia with a glucose level of 1093 mg/dL and severe hypernatremia with a serum sodium level of 169 mEq/L.He was admitted to the intensive care unit(ICU)and was started on insulin drip as per DKA protocol.Within 12 h of ICU admission,blood sugar was 300 mg/dL.But his mental status didn’t show much improvement.He was dehydrated and had a corrected serum sodium level of>190 mEq/L.As a result,dextrose 5%in water and ringer's lactate were started.He was also given free water via an nasogastric(NG)tube and IV Desmopressin to improve his free water deficit,which improved his serum sodium to 140 mEq/L.CONCLUSION The combination of DKA,HHS and hypernatremia is rare and extremely challenging to manage,but the most challenging part of this condition is selecting the correct type of fluids to treat these conditions.Our case illustrates that desmopressin and free water administration via the NG route can be helpful in this situation.展开更多
Purpose: Prolotherapy is a therapeutic method that involves injecting an irritant substance into injured areas of tendons, ligaments, and articular spaces. It has a wide application in orthopedic fields, including art...Purpose: Prolotherapy is a therapeutic method that involves injecting an irritant substance into injured areas of tendons, ligaments, and articular spaces. It has a wide application in orthopedic fields, including arthritis, tendinopathies, and back pain. Protocol of injection varies extensively based on the pathological condition. This review aims to discuss orthopedic applications of prolotherapy and its related outcomes, intending to introduce more specific injection protocols in each field. Methods: In a narrative review of literature, various musculoskeletal indications and contraindications of prolotherapy, as well as the method and location of injection, solution type, procedure intervals and frequencies, outcomes and side effects are investigated to reveal all aspects of the current knowledge about this new approach. Results: Chronic back pain, osteoarthritis, and tendinopathies are considered the most common indications for prolotherapy. Protocol of injection varies from one condition to another. The actual concentration of administered dextrose ranges from 12.5% to 25%. Results of the different studies indicate that prolotherapy could have a pleasing effect on improving patient’s pain and functional outcomes. No severe complication has been mentioned in previous investigations. Conclusion: Prolotherapy is a new therapeutic option that can be suggested as an effective method in recalcitrant musculoskeletal conditions.展开更多
文摘Diabetic ketoacidosis(DKA)and hyperosmolar hyperglycemia state(HHS)are two life-threatening metabolic complications of diabetes that significantly increase mortality and morbidity.Despite major advances,reaching a uniform consensus regarding the diagnostic criteria and treatment of both conditions has been challenging.A significant overlap between these two extremes of the hyperglycemic crisis spectrum poses an additional hurdle.It has well been noted that a complete biochemical and clinical patient evaluation with timely diagnosis and treatment is vital for symptom resolution.Worldwide,there is a lack of large-scale studies that help define how hyperglycemic crises should be managed.This article will provide a comprehensive review of the pathophysiology,diagnosis,and management of DKA-HHS overlap.
文摘AIM:To investigate the mechanism of the tight junction(TJ) disruption and the association between tumor necrosis factor(TNF)-α and matrix metalloproteinase(MMPs) under hyperosmotic condition in primary human corneal epithelial cells(HCECs).METHODS:The cultured HCECs were exposed to media which adding sodium chloride(Na Cl) for hyperosmolar stress or adding rh-TNF-α(10 ng/m L). NF-κB inhibitor(5 μmol/L) or GM-6001(potent and broad spectrum MMP inhibitor, 20 μmol/L)was added 1 h before that treatment. The integrity of TJ proteins was determined by immunofluorescent(IF) staining. The m RNA levels of TNF-α and MMPs were evaluated by quantitative reverse transcription polymerase chain reaction(RT-q PCR) and the protein expression by enzyme-linked immunosorbent assay(ELISA).RESULTS:TJ proteins ZO-1 and Occludin were disrupted in primary HCECs exposed to hyperosmotic medium. The m RNA expression and protein production of TNF-α increased significantly in hyperosmotic media at 500 m Os M. TNF-α mediated the expression and production of MMP-1, MMP-13, MMP-9, and MMP-3 stimulated by hyperosmotic stress. The production of MMPs in hyperosmolar media were increased through the increase of TNF-α. GM-6001 prevent the destruction of ZO-1 and Occludin in hyperosmolar stress and rh-TNF-α treated medium. TNF-α induced activation of MMPs was involved in the TJ disruption by hyperosmolarity.CONCLUSION:TJ proteins ZO-1 and Occludin are disrupted by hyperosmolar stress and TNF-α, but protected by MMP inhibitor(GM-6001). It suggests that TNF-α/MMP pathway mediates the TJ disruption in primary HCECs exposed to hyperosmotic stress.
文摘To protect from COVID-19 pandemic, several vaccines were developed infection with expected immunity against a SARS-CoV-2 infection. Short time side effects are reported. New onset diabetes was reported after SARS-CoV-2 infection. Here we report a case of new onset diabetes presenting with hyperosmolar hyperglycemic state, whose symptoms followed right after the second dose of Pfizer-BioNTech COVID-19 Vaccine. He is a 56-year old, obese Afro-American Veteran with no family history of diabetes and with HbA1C of 5.6 forty-five days prior to the hospitalization. He noted polyurea and excessive thirst following the second dose Pfizer-BioNTech COVID-19 vaccine. Hospitalized with hyperosmolar state and HbA1C of more than 14, he was treated initially with insulin drip and changed to basal, bolus regimen. In addition, he had new onset of oral thrush, requiring antifungal therapy. He needed higher doses of insulin during hospitalization and at discharge. He rapidly recovered and could be tapered off insulin in 4 months and recovered to normal glycemic state. We conclude that this is the second state to present with hyperosmolar state, and first case with rapid recovery of glycemic state.
文摘BACKGROUND Diabetic ketoacidosis(DKA)and hyperglycemic hyperosmolar state(HHS)are common acute complications of diabetes mellitus with a high risk of mortality.When combined with hypernatremia,the complications can be even worse.Hypernatremia is a rarely associated with DKA and HHS as both are usually accompanied by normal sodium or hyponatremia.As a result,a structured and systematic treatment approach is critical.We discuss the therapeutic approach and implications of this uncommon presentation.CASE SUMMARY A 62-year-old man with no known past medical history presented to emergency department with altered mental status.Initial work up in emergency room showed severe hyperglycemia with a glucose level of 1093 mg/dL and severe hypernatremia with a serum sodium level of 169 mEq/L.He was admitted to the intensive care unit(ICU)and was started on insulin drip as per DKA protocol.Within 12 h of ICU admission,blood sugar was 300 mg/dL.But his mental status didn’t show much improvement.He was dehydrated and had a corrected serum sodium level of>190 mEq/L.As a result,dextrose 5%in water and ringer's lactate were started.He was also given free water via an nasogastric(NG)tube and IV Desmopressin to improve his free water deficit,which improved his serum sodium to 140 mEq/L.CONCLUSION The combination of DKA,HHS and hypernatremia is rare and extremely challenging to manage,but the most challenging part of this condition is selecting the correct type of fluids to treat these conditions.Our case illustrates that desmopressin and free water administration via the NG route can be helpful in this situation.
文摘Purpose: Prolotherapy is a therapeutic method that involves injecting an irritant substance into injured areas of tendons, ligaments, and articular spaces. It has a wide application in orthopedic fields, including arthritis, tendinopathies, and back pain. Protocol of injection varies extensively based on the pathological condition. This review aims to discuss orthopedic applications of prolotherapy and its related outcomes, intending to introduce more specific injection protocols in each field. Methods: In a narrative review of literature, various musculoskeletal indications and contraindications of prolotherapy, as well as the method and location of injection, solution type, procedure intervals and frequencies, outcomes and side effects are investigated to reveal all aspects of the current knowledge about this new approach. Results: Chronic back pain, osteoarthritis, and tendinopathies are considered the most common indications for prolotherapy. Protocol of injection varies from one condition to another. The actual concentration of administered dextrose ranges from 12.5% to 25%. Results of the different studies indicate that prolotherapy could have a pleasing effect on improving patient’s pain and functional outcomes. No severe complication has been mentioned in previous investigations. Conclusion: Prolotherapy is a new therapeutic option that can be suggested as an effective method in recalcitrant musculoskeletal conditions.
